Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies

Obstructive sleep apnea (OSA) is one of the common sleep breathing disorders in adults, characterised by frequent episodes of upper airway collapse during sleep. Craniofacial disharmony is an important risk factor for OSA. Overnight polysomnography (PSG) study is considered to be the most reliable confirmatory investigation for OSA diagnosis, whereas the precise localization of site of obstruction to the airflow cannot be detected. Identifying the cause of OSA in a particular ethnic population/individual subject helps to understand the etiological factors and effective management of OSA. The objective of the meta-analysis is to elucidate altered craniofacial anatomy on lateral cephalograms in adult subjects with established OSA. Significant weighted mean difference with insignificant heterogeneity was found for the following parameters: anterior lower facial height (ALFH: 2.48 mm), position of hyoid bone (Go-H: 5.45 mm, S–H: 6.89 mm, GoGn-H: 11.84°, GoGn-H: 7.22 mm, N–S–H: 2.14°), and pharyngeal airway space (PNS-Phw: −1.55 mm, pharyngeal space: −495.74 mm2 and oro-pharyngeal area: −151.15 mm2). Significant weighted mean difference with significant heterogeneity was found for the following parameters: cranial base (SN: −2.25 mm, S–N–Ba: −1.45°), position and length of mandible (SNB: −1.49° and Go-Me: −5.66 mm) respectively, maxillary length (ANS-PNS: −1.76 mm), tongue area (T: 366.51 mm2), soft palate area (UV: 125.02 mm2), and upper airway length (UAL: 5.39 mm). This meta-analysis supports the relationship between craniofacial disharmony and obstructive sleep apnea. There is a strong evidence for reduced pharyngeal airway space, inferiorly placed hyoid bone and increased anterior facial heights in adult OSA patients compared to control subjects. The cephalometric analysis provides insight into anatomical basis of the etiology of OSA that can influence making a choice of appropriate therapy.